Lumbosacral plexopathy from iliopsoas haematoma after combined general-epidural anaesthesia for abdominal aneurysmectomy.
OBJECTIVE
To report a case of iliopsoas haematoma after resection of an abdominal aortic aneurysm which resulted in a lumbosacral plexopathy.


METHODS
An 81-yr-old man presented with an abdominal aortic aneurysm for aneurysmectomy and tube grafting. An epidural catheter was placed at the L1-2 spinal level and combined epidural-general anaesthesia was provided for surgery. The surgery was complex and a suprarenal clamp was necessary to obtain proximal control. A continuous infusion of demerol through the epidural catheter was prescribed for postoperative analgesia. On the first postoperative day, examination revealed a paretic, pulseless right leg and he was returned to the operating room for femoral-femoral bypass. By the following day, the motor and sensory impairment had progressed to complete paralysis with loss of all deep tendon reflexes and absent sensation below L1, despite palpable pulses in the leg. A CT of the abdomen demonstrated a right iliopsoas haematoma. There was no evidence of either disc herniation or an epidural haematoma. A diagnosis of lumbosacral plexopathy secondary to a iliopsoas haematoma was made.


CONCLUSIONS
Iliopsoas haematoma is a rare cause of postoperative neurological deficit following aortic vascular surgery. The haematoma results in compression of the lumbosacral neural elements and typically presents as a femoral neuropathy. The diagnosis is clinical and can be readily validated with computed tomography.
Crosby
E T
ET
Department of Anaesthesia, University of Ottawa, Ottawa General Hospital. ecrosby@fox.nstn.ca
Reid
D R
DR
DiPrimio
G
G
Grahovac
S
S
D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000767:Anesthesia, Epidural; D000768:Anesthesia, General; D017544:Aortic Aneurysm, Abdominal / Q000601:surgery*; D003250:Constriction; D006406:Hematoma / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000601:surgery; D008160:Lumbosacral Plexus / Q000473:pathology*; D008297:Male; D008614:Meperidine / Q000008:administration & dosage / Q000627:therapeutic use; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000473:pathology*; D009135:Muscular Diseases / Q000150:complications / Q000000981:diagnostic imaging; D010149:Postoperative Pain / Q000188:drug therapy; D010243:Paralysis / Q000209:etiology; D010291:Paresis / Q000209:etiology; D010523:Peripheral Nervous System Diseases / Q000209:etiology; D016658:Psoas Muscles / Q000000981:diagnostic imaging / Q000473:pathology*; D012021:Reflex, Abnormal / Q000502:physiology; D012026:Reflex, Stretch / Q000502:physiology; D013848:Thigh / Q000098:blood supply; D014057:Tomography, X-Ray Computed
D000701:Analgesics, Opioid; D008614:Meperidine